title: Modeling the impact of simulated educational interventions on the use and abuse of pharmaceutical opioids in the United States: a report on initial efforts.
abstract: Three educational interventions were simulated in a system dynamics model of the medical use, trafficking, and nonmedical use of pharmaceutical opioids. The study relied on secondary data obtained in the literature for the period of 1995 to 2008 as well as expert panel recommendations regarding model parameters and structure. The behavior of the resulting systems-level model was tested for fit against reference behavior data. After the base model was tested, logic to represent three educational interventions was added and the impact of each intervention on simulated overdose deaths was evaluated over a 7-year evaluation period, 2008 to 2015. Principal findings were that a prescriber education intervention not only reduced total overdose deaths in the model but also reduced the total number of persons who receive opioid analgesic therapy, medical user education not only reduced overdose deaths among medical users but also resulted in increased deaths from nonmedical use, and a "popularity" intervention sharply reduced overdose deaths among nonmedical users while having no effect on medical use. System dynamics modeling shows promise for evaluating potential interventions to ameliorate the adverse outcomes associated with the complex system surrounding the use of opioid analgesics to treat pain.
authors.affiliation: 1Portland State University, Portland, OR, USA.
authors.forename: Wayne
authors.initials: W
authors.lastname: Wakeland
authors.forename: Alexandra
authors.initials: A
authors.lastname: Nielsen
authors.forename: Teresa D
authors.initials: TD
authors.lastname: Schmidt
authors.forename: Dennis
authors.initials: D
authors.lastname: McCarty
authors.forename: Lynn R
authors.initials: LR
authors.lastname: Webster
authors.forename: John
authors.initials: J
authors.lastname: Fitzgerald
authors.forename: J David
authors.initials: JD
authors.lastname: Haddox
mesh_terms: D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D003198:Computer Simulation; D062787:Drug Overdose / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D006282:Health Personnel / Q000193:education*; D006801:Humans; D017145:Models, Educational; D008962:Models, Theoretical; D009293:Opioid-Related Disorders / Q000401:mortality / Q000517:prevention & control*; D010353:Patient Education as Topic; D064226:Prescription Drug Diversion / Q000517:prevention & control* / Q000706:statistics & numerical data; D018570:Risk Assessment; D013597:Systems Analysis; D014481:United States / Q000453:epidemiology
chemical_list: D000701:Analgesics, Opioid
keywords: alcohol and substance abuse; dynamic modeling; modeling and simulation; nonlinear dynamics; substance use; systems science